In Allegheny County, school nurses on the front line of student asthma

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Annie Johnson, a nurse at Wilkins Elementary in Wilkins, helps students deal with asthma pretty much every day.

Sometimes, it's as easy as handing them their inhalers after gym. For more serious attacks, she has them sit down and stare at a hologram that changes back and forth with their breathing, to help them relax. When that doesn't work, she calls their parents, or, as a last resort, 911.

"I haven't had to call an ambulance yet this year for an asthmatic kid," Ms. Johnson said, knocking on a wooden desk.

Ms. Johnson's experience isn't unusual for a school nurse in Allegheny County, where 12.1 percent of children were diagnosed with asthma in 2009, according to the Pennsylvania Department of Health. The condition is especially prevalent in the county's low-income and African-American communities, said Deborah Gentile, director of research, allergy, asthma and immunology at the Allegheny Health Network.

PG graphic: Asthma prevalence(Click image for larger version)

The expertise of nurses like Ms. Johnson has attracted the attention of health advocates looking for better ways to fight asthma. Working so closely with students, nurses are sometimes the first to notice their asthma symptoms, Dr. Gentile said. They're in a good position to tell whether a new medication is effective. They also help teach students about the disease, showing them how to use an inhaler and calm down during an attack.

"The nurses are really on the front line," said Dr. Gentile, who has collaborated with nurses to screen students for asthma.

Jeannie Simms, director of field services at Breathe Pennsylvania, a nonprofit dedicated to lung health, has been working with school nurses for more than a decade. To help them treat children with asthma, she gives them toolkits containing, among other things, extra medication for students who forget to bring theirs to school. The nurses also recruit students and parents for classes about managing asthma.

Ms. Simms also runs classes in which professionals like pharmacists and respiratory therapists teach nurses more about the disease.

"It's not like a hospital setting, where a nurse can call for support from a respiratory therapist or a physician," Ms. Simms said. "So we really wanted to provide support for the nurses."

When Michael Yonas, director of research, evaluation and engagement at the Allegheny County Department of Human Services, was looking for ways to learn more about asthma, Ms. Simms suggested he talk with school nurses. In a study he conducted while working at the Department of Family Medicine at the University of Pittsburgh, he tapped the knowledge of 11 school nurses from Pittsburgh Public Schools and the Woodland Hills School District, including Ms. Johnson.

In 2012, Dr. Yonas used software to gather the nurses' observations about what affects the health of students with asthma. Then the nurses gathered in the Pittsburgh Federation of Teachers headquarters on the South Side so they could exchange insights over takeout dinner.

Many of the asthma triggers the nurses cited are well known, such as car exhaust, tobacco smoke and allergies. Some of them reflect their intimate view of students' lives. Bullying was a factor in some attacks, they said, because of the stress it causes. Attacks can also be sparked by anxiety over poor grades, body image, moving to a new home, domestic violence and dangerous streets, the nurses said.

"I could never have generated their depth of understanding," Dr. Yonas said. "They were really driving the research process. I was just orchestrating it."

The nurses also suggested that asthma treatment would be improved if they had better communication with students' doctors. Juanita Hogan, a nurse at Pittsburgh Public Schools, said it usually isn't difficult for her to reach the students' doctors, but she thinks the communication should be more automatic. If a student went to the emergency room for an asthma attack over the weekend, the school nurse should be told about it on Monday, she said.

"We're extensions of the medical plans that doctors have for the children," Ms. Hogan said.

Dr. Yonas has presented the findings of the study, which was funded by the National Institutes of Health. He hopes to publish it in an academic journal for the nursing profession.

In addition to providing insight on asthma treatment, the nurses' meeting was useful because it established connections between the nurses that could lead to more collaboration, Dr. Yonas said.

"I know it sounds corny, but it seemed like family," Dr. Yonas said. "I really enjoyed it and learned a ton. And I made some close friends, too."

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